Action Points

The vast majority of sepsis infections begin outside the hospital setting and many could be avoided with greater emphasis on preventing sepsis in the very old, the very young, and patients with chronic conditions, according to the CDC.

Note that increased use of outpatient infection prevention strategies, such as vaccination and appropriate management of patients with chronic diseases, could lead to dramatic reductions in sepsis and death.

The vast majority of sepsis infections begin outside the hospital setting and many could be avoided with greater emphasis on preventing sepsis in the very old, the very young, and patients with chronic conditions, according to the CDC.

Increased use of outpatient infection prevention strategies, such as vaccination and appropriate management of patients with chronic diseases, could lead to dramatic reductions in sepsis cases and death, wrote Lauren Epstein, MD, of the CDC in Atlanta, and colleagues in the Morbidity and Mortality Weekly Report.

It is estimated that between 1 and 3 million people are diagnosed with sepsis each year, and between 15% and 30% of patients die from the infection.

In a telebriefing with reporters, CDC Director Tom Frieden, MD, announced the launch of a campaign in conjunction with physician and patient partnership organizations designed to raise awareness about sepsis prevention and early recognition of sepsis infection.

The five areas of focus in the coordinated sepsis prevention initiative are:

Increasing sepsis awareness among patients, families, and providers and building a coalition of clinical professional partners and patient advocates to work with CDC

Promoting early recognition of sepsis and aligning antibiotic stewardship with early recognition

Identifying at-risk populations for prevention and early recognition efforts

Preventing infections that lead to sepsis, including infections caused by antibiotic-resistant pathogens

"Sepsis is a medical emergency and we can protect more people by informing patients and families, by empowering them to ask, 'Could this be sepsis?,' by treating infections promptly, and by preventing infections when possible, and acting fast when sepsis does occur," Frieden said.

Eight out of 10 (79.4%) patients hospitalized for sepsis were classified as having sepsis onset outside the hospital in a retrospective medical record review conducted by Epstein's group.

Seven in 10 sepsis patients had visited their doctor, or used other healthcare services, soon before hospitalization or had chronic diseases that required frequent medical care, highlighting the need for greater sepsis prevention efforts in outpatient medical care.

"We find -- and this is surprising to many people who work in this field -- that sepsis begins outside the hospital for nearly 80% of patients," Frieden said. "We have been focusing on, and making progress, in reducing sepsis within hospitals -- in intensive care units, long-term care facilities, and elsewhere."

He noted that the findings in the new report show that outpatient healthcare providers are on the front lines of sepsis prevention and early recognition.

Frieden shared his own family's first-hand experience with the life-threatening infection to illustrate that sepsis is, "both a medical emergency and a race against time."

"Twenty-two years ago, when our older son was just 4-months old, I came home from work one day to find him near death. He was completely pale and I didn't know if he was breathing or not," he said.

Fortunately, the sepsis was rapidly identified and treated, and his son completely recovered.

"But he could have died from it, and far too many people do die from sepsis today," Frieden said.

The current review included patients hospitalized from Oct. 1, 2012 to Sept. 30, 2013 with a discharge diagnosis of severe sepsis or septic shock at four general, acute care hospitals in New York.

The median age of the 246 patients included in the analysis was 69, about half were males (525), and the median length of hospital stay was 9 days.

The vast majority (97%) of the patients in the review had at least one comorbidity, with 35% having diabetes mellitus, 32% with cardiovascular disease, 23% with chronic kidney disease, and 20% with chronic obstructive pulmonary disorder.

Pneumonia was the most common infection leading to sepsis. The most common pathogens isolated from blood cultures were Escherichia coli in adults aged ≥18 years, Klebsiella spp. in children aged ≥1 year, and Enterococcus spp. in infants aged <1 year. One-third of patients had no specific pathogen isolated. One in four died of the infection, including 65 (26%) adults and 17 (22%) infants and children.

Frieden said education efforts aimed at the public should begin with recognition of the key signs and symptoms of sepsis, which include:

Last year, the Centers for Medicare & Medicaid Services implemented new policies designed to increase the use of specific medical interventions for sepsis during the first few hours of hospital treatment.

The CDC sepsis report noted that because different types of infections can lead to sepsis, many healthcare interventions that are currently viewed as pathogen-specific or disease-specific should also be considered opportunities to prevent sepsis and included in efforts to improve sepsis education.

Since pneumonia is the most common infection causing sepsis, the researchers noted that pneumococcal vaccination is an important and highly effective prevention strategy.

"Pneumococcal and influenza vaccination have both been shown to have saved thousands of lives, despite suboptimal vaccination coverage in the U.S. population; thousands more deaths could be prevented with better coverage," they wrote.

Epstein and co-authors disclosed no relevant relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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